Geriatric assessment guided interventions:The role of occupational therapy and allied

health

Mackenzi Pergolotti, PhD, OTR/L

ReVital Cancer Rehabilitation, Select Medical, USA

Colorado State University

University of North Carolina at Chapel Hill

Meet Cliff …“Life isn’t as carefree as it used to

be”

“I feel like I’m

walking with moon

boots.”

Neo, J., Fettes, L., Gao, W., Higginson, I. J., & Maddocks, M. (2017). Disability in activities of daily living among adults with cancer: A systematic review and meta-analysis. Cancer Treatment Reviews, 61, 94-106. doi:https://doi.org/10.1016/j.ctrv.2017.10.006

1/3 describe difficulty with activities of daily living

1/2 describe challenges with instrumental activities of daily living

• 30% report health as fair/poor

• 50 % have pain

• 20 % have an impairment in IADL

• 83 % already receiving some assistance

• 11 % dementia

Mohile, S. G., Dale, W., Somerfield, M. R., Schonberg, M. A., Boyd, C. M., Burhenn, P. S., ... & Janelsins, M. C. (2018). Practical assessment and management of vulnerabilities in older patients receiving chemotherapy: American Society of Clinical Oncology Guideline for Geriatric Oncology. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 36(22), 2326.

“The evidence supports, at a minimum, assessment of function, comorbidity, falls,

depression, cognition, and nutrition”

Increased Risk:

*Chemotherapy Toxicity

*Unplanned Hospitalization

*Mortality

Mobility Issue

Decreased Performance

Status

Severe Co-morbid

Conditions

+ 1 Fall

van Abbema DL, van den Akker M, Janssen-Heijnen ML, et al. (2018). Patient-and tumor-related predictors of chemotherapy intolerance in older patients with cancer: A systematic review. Journal of Geriatric Oncology.

Why Cancer Rehabilitation?Predictors of chemotherapy intolerance

Falls• “only” 1

Function• Mobility• ADL• IADL

Cognition• Attention• Memory

Cancer

Comorbidities:• Diabetes• Arthritis• Macular degeneration

Activity

Photo by Ban Yido on Unsplash

Participation

Note. PROMIS physical health, PROMIS mental health and FACT-G plotted against Patient-Generated Subjective Global Assessment- Activities/ Function (PG-SGA-AF); Response options for activities/ function range from 0 “normal activity with no limitations” to 4 “pretty much bedridden, rarely out of bed”.

Significant decline in QOL associated with lower levels of activity and function

Pergolotti, M., Deal, A. M., Williams, G. R., Bryant, A. L., Bensen, J. T., Muss, H. B., & Reeve, B. B. (2017). Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. Journal of geriatric oncology, 8(4), 249-254.

What can rehabilitation do?

Screen Assess Intervene

The Role of Cancer Rehabilitation:Living Well Beyond Cancer

Cancer & Anticipated Side Effects

Improved function,

activity and participation

Oncology Medicine &

NursingPhysical TherapyPhysical Therapy

Occupational Therapy

Occupational Therapy

Speech & Language Pathology

Speech & Language Pathology

Physiatry & Rehab Nursing

Psychology & Psychiatry

Social work & Case

Management

Exercise Physiology

Audiology

Nutrition and Dietetics

Cardiology, Endocrinology,

Neurology

Dentistry

Restore Function

Reduce risk of late effects

Improve Quality of

Life

Restore Participation (work, life)

Components of Comprehensive Cancer Rehabilitation Care

Reproduced from: Alfano CM, Pergolotti M. Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabilitation Nursing Journal. 2018 Jul 1;43(4):186-94.

Prospective Surveillance Model

Personal Factors

Environmental Factors

Diagnosis/ Pre-op

Treatment Survivorship End of Life

Cancer Care Continuum

Reproduced from: Alfano CM, Pergolotti M. Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabilitation Nursing

Journal. 2018 Jul 1;43(4):186-94.

Function• Mobility• ADL• IADL

Falls• “only” 1

Cognition• Attention• Memory

Comorbidities:• Diabetes• Arthritis• Macular degeneration

Cancer

Activity:Wearing button-downs

Zippers

Participation:Social events

Yard-workWoodworking

Speech and Swallowing

Function• Mobility• ADL• IADL

Falls• “only” 1

Cognition• Attention• Memory• Speech

CancerCo-

morbidities

Physical Therapy

Occupational Therapy

Speech and Language

Speech and Swallowing

Activity:Wearing button-downs

Zippers

Participation:Social events

Yard-workWoodworking

What can rehabilitation do?

Supervised

Targeted

Problem solving-adapting

Engagement in activity and participation improves QOL

Occupational therapy• Improved QOL, function and

mental health

• Improved problem-solving

• Self-efficacy and activity expectations

(Cheville, 2005; Cheville & Tchou, 2007; Lyons, 2006; Lyons, Erickson, & Hegel, 2012; Lyons, Orozovic, Davis, & Newman, 2002; Pergolotti, Cutchin, & Muss, 2014; Pergolotti, Cutchin, Weinberger, & Meyer, 2014; Pergolotti, Deal, Lavery, Reeve, & Muss, 2015; Unruh & Elvin, 2004; Vrkljan & Miller-Polgar, 2001)

Speech and language• Improved swallowing• Decreased trismus

Physical therapy• Increased physical

activity• Increased strength• Decreased fatigue

Cancer RehabilitationSpecialists in Function, Activity & Participation

Thank you

mpergolotti@selectmedical.com@mpergolottiPhD